MCH left out of state network

Hospital says it was never given an option by Anthem

PETERBOROUGH — Monadnock Community Hospital, one of the state’s 13 federally designated critical access hospitals, will not be part of the network that Anthem Blue Cross and Blue Shield is developing for the New Hampshire health insurance exchange program under the terms of the federal Affordable Care Act.

As result, area residents who want to buy insurance through the ACA exchange may have to travel to hospitals or doctors that are further away, although Cheshire Medical Center in Keene will be participating in Anthem’s program.

According to an announcement released last week by Anthem, the company chose to offer a “select provider network” of 18 New Hampshire hospitals and one hospital in Burlington, Mass., in order to offset premium increases that would be necessary due to predicted higher claims from previously uninsured people and those covered through existing high-risk pools.

“Anthem decided on this without discussing it with us,” said Monadnock Community Hospital CEO Peter Gosline on Monday. “My guess is that they were doing what they needed to do to meet federal requirements. We hope this is just their way to get into the market for the first year.”

Anthem is the only health insurance provider participating in the ACA health exchange program in New Hampshire. Anthem’s provider network, called Pathway, “meets all New Hampshire network adequacy requirements and offers a price point that is approximately 25 percent lower than a product using a broad network,” according to the Anthem press release. Uninsured individuals and small companies will be eligible to sign up for the program, which is slated to go into effect on Jan. 1, 2014.

The release states that the providers in the Pathway network are offering rate concessions for individual exchange customers, many of whom may not have had coverage previously. “Without the use of the new network, all individual exchange members would have seen much higher premiums than they will now see,” the release states.

The new network is intended to serve only those who will be getting insurance through the provisions of the Affordable Care Act. Employees who receive their health benefits through Anthem’s contracts with small or large group employers will not be affected. Nor will seniors on Medicare or individuals who purchased plans prior to March 23, 2010.

According to the press release, the Pathway Network will include 74 percent of the state’s primary-care physicians, 85 percent of specialists and 83 percent of ambulatory surgery providers.

Among the 16 hospitals that are included in the Pathway network are Cheshire Medical Center in Keene, Catholic Medical Center in Manchester, Eliot Hospital in Manchester and St. Joseph’s Hospital in Nashua.

Art Nichols, the chief executive officer of Cheshire Medical Center, said he was not surprised that Anthem approached the Keene hospital.

“They had to have someone over in this corner of the state,” Nichols said on Monday. “We’re the only hospital in the county.”

Nichols said Cheshire Medical officials understood that reimbursement rates would be less than under the traditional Anthem model.

“We chose to participate,” he said. “We couldn’t envision a scenario where we would leave the whole county without service. You have a responsibility to the patients. So we opted in.”

Gosline said Anthem’s decision does not affect the majority of Monadnock Community Hospital’s patients and participants in the exchange will still be able to come to MCH for emergency care.

He said employers with fewer than 50 employees could choose to buy insurance from Anthem through the exchange.

“We don’t anticipate that all the small employers will jump on this,” Gosline said. “We believe it is mainly individuals who are going to be impacted.”

Gosline hopes that in the second year, Anthem will include MCH in its discussion of participation options. He said the Affordable Care Act exchanges are in just their first year, and lots of changes are expected.

“I wouldn’t be surprised if there are other companies that might come in during the second year,” he added.

Dave Anderson can be reached at 924-7172, ext. 233 or danderson@ledgertranscript.com. He’s on Twitter at @DaveAndersonMLT.

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